The Consumers Union Report on Licit and Illicit Drugs

by Edward M. Brecher and the Editors of Consumer Reports Magazine, 1972

Chapter 4. Effects of opium, morphine, and heroin on addicts

The popular view of the effects of narcotics on addicts was eloquently expressed in a 1962 decision of the Supreme Court of the United States:

To be a confirmed drug addict is to be one of the walking dead. . . . The teeth have rotted out, the appetite is lost, and the stomach and intestines don't function properly. The gall bladder becomes inflamed; eyes and skin turn a bilious yellow; in some cases membranes of the nose turn a flaming red; the partition separating the nostrils is eaten away-breathing is difficult. Oxygen in the blood decreases; bronchitis and tuberculosis develop. Good traits of character disappear and bad ones emerge. Sex organs become affected. Veins collapse and livid purplish scars remain. Boils and abscesses plague the skin; gnawing pain racks the body. Nerves snap; vicious twitching develops. Imaginary and fantastic fears blight the mind and sometimes complete insanity results. Often times, too, death comes-much too early in life. . . . Such is the torment of being a drug addict; such is the plague of being one of the walking dead. 1

The scientific basis for this opinion, however, is not easy to find. In 1956, when Dr. George H. Stevenson and his British Columbia associates made their inquiry into narcotics addiction, they exhaustively reviewed the medical literature on the subject.

"When we began this project," they explained,

. . . it was immediately apparent to us that the actual deleterious effects of addiction on the addicts and on society, should be clearly understood. . . . To our surprise we have not been able to locate even one scientific study on the proved harmful effects of addiction. Earlier investigators had apparently assumed that the ill effects were so obvious as not to need scientific verification. ... We have assembled over 500 documents on various phases of addiction . . ., but not one of them offers a clear-cut, scientifically valid statement on this problem. 2

A likely place to seek such a statement, the Stevenson group assumed, was in The Traffic in Narcotics (1953), by United States Commissioner of Narcotics Harry J. Anslinger, in collaboration with United States Attorney William F. Tompkins. Yet Anslinger and Tompkins had "only a single reference to the harmful effects of narcotic drugs, in which they quote another authority to the effect that the use of narcotic drugs leads to 'a decrease in the potential social productivity of the addict.' " Even this statement, the Stevenson group added, "is not supported in the book by any scientific evidence." 3

The British Columbia report continued:

We finally wrote to some of the most eminent research workers in the field of drug addiction, explaining our problem and requesting scientific data on the deleterious effects of narcotic drugs. They indicated, in their reply, that there was no real evidence of brain damage or other serious organic disease resulting from the continued use of narcotics (morphine and related substances), but that there was undoubted psychological and social damage. However, they made no differentiation between such damage as might be caused by narcotics and that which might have been present before addiction, or might have been caused, at least in part, by other factors. Moreover, they were unable to direct us to any actual studies on the alleged harmful effects of narcotic drugs.

At a later date we also consulted officials of the United Nations Commission on Narcotic Drugs, and they, too, were unable to direct us to any scientific studies on the actual damaging effects of morphine or heroin addiction.

The Narcotic Control Division of the Canadian Government's Department of Health and Welfare was likewise unable to direct us to scientific studies on this subject. 4

A review of the literature since the 1956 British Columbia study, undertaken in preparation of this Consumers Union Report, has been only slightly more rewarding. Almost all of the deleterious effects ordinarily attributed to the opiates, indeed, appear to be the effects of the narcotics laws instead.

By far the most serious deleterious effects of being a narcotics addict in the United States today are the risks of arrest and imprisonment, infectious disease, * and impoverishment-all traceable to the narcotics laws, to vigorous enforcement of those laws, and to the resulting excessive black-market prices for narcotics. Here, however, we are concerned with the effects of opiate use on addicts under conditions of low cost and legal availability-in other words, the effects of the drugs themselves as distinct from the effects of economic, social, and legal factors.

* When opiates are cheap, addicts generally eat them, sniff them, or smoke them (as an estimated 90 to 95 percent of American heroin users in Vietnam did in 1971; 5 (see Chapter 20). When the drug cost is high, the same effects are achieved by injecting smaller amounts subcutaneously ("skin-popping") or intravenously ("mainlining"). Such injections, often carried out with crude and unsterile implements, contribute to the risk of infectious disease among addicts. The likelihood of infection is further increased by United States laws making it a crime to possess or sell needles, syringes, or other paraphernalia without a prescription; addicts minimize the risk of arrest by sharing their injection equipment--- thus inviting cross-infection.

The classical clinical study of the effects of prolonged opiate use on the human body was performed in the narcotics wards of the Philadelphia General Hospital during the 1920s, under the impeccable auspices of the Committee on Drug Addictions of the Bureau of Social Hygiene--- a Rockefeller-financed agency--- and of the Philadelphia Committee for the Clinical Study of Opium Addiction. In charge were two physicians, Drs. Arthur B. Light and Edward G. Torrance, assisted by a biochemist, Dr. Walter G. Karr, and by Edith G. Fry and William A. Wolff. The results were published by the American Medical Association in the A.M.A. Archives of Internal Medicine (1929), and in a book, Opium Addiction. 6 The findings of this study are still cited as authoritative in medical textbooks.

In all, 861 male addicts--- 80 percent of them addicted to heroin and the others to morphine or other opiates--- participated in various phases of this study. Most of them were between twenty and forty years of age. They came to the hospital more or less voluntarily (in some cases, no doubt, to escape arrest) for the stated purpose of being "cured." Most of them were criminals and most of them were poor; then as now, affluent addicts did not go to a city hospital for treatment. Here is the broad general conclusion which Dr. Light and his associates reached:

The study shows that morphine addiction is not characterized by physical deterioration or impairment of physical fitness aside from the addiction per se. There is no evidence of change in the circulatory, hepatic, renal or endocrine functions. When it is considered that these subjects had been addicted for at least five years, some of them for as long as twenty years, these negative observations are highly significant. 7

Details of the study were equally striking. For example, the narcotics addict is popularly portrayed as lean, gaunt, emaciated. A subgroup of about 100 addicts out of the 861 in the Philadelphia study was maintained on adequate doses of morphine and intensively examined and tested while thus maintained. Only four of the 100 were grossly underweight --- emaciated. Six of the 100 were grossly overweight--- obese. The group as a whole weighed within two-tenths of one percent of the norm for their height and age, as determined by Metropolitan Life Insurance Company standards. Yet these addicts before hospitalization had been taking on the average 21 grains of morphine or heroin per day 8 --- more than 30 times the usual dose of the New York City street addict in 1971.

The explanation for the weight findings, which could hardly be more normal, is quite simple. The addicts in the Philadelphia study had ready access to both hospital food and hospital morphine. Under these conditions, they ate well and thrived. The emaciated addict usually described in other studies is one who starves himself to save money for black market drugs--- an ordeal he is able to bear more easily because of the tranquilizing effect of the drugs. The Philadelphia study established that addicts eat like anyone else when both food and drugs are readily available.

The addict is also customarily portrayed as sallow-complexioned. But, Dr. Light and his associates noted, "this change in color was practically always present in patients who lived a rather unhygienic, sedentary life. On the other hand, the skin of those who followed healthy outdoor occupations had the color of excellent health." 9

The Philadelphia group did notice "a slight degree of anemia" in some of their addicts on admission. This may be present, they added, "when the addict is forced to live in poor hygienic surroundings [and] when all his funds are required to purchase the drug at the expense of sufficient nourishing foods." 10

Dr. Light and his associates confirmed that 60 percent of the Philadelphia addict group "exhibited a particularly high degree of pyorrhea and dental caries"--- but "one must bear in mind that these people are notorious in their lack of care of the teeth and failure to consult a dentist." 11 Malnutrition may also have been a factor. Whatever the cause, there is no evidence that narcotics "rot the teeth." The 1956 British Columbia study also noted a high degree of tooth decay among imprisoned addicts--- but found comparable decay in a comparison group of prisoners who were not addicted. 12 Perhaps the chief effect of narcotics on the teeth is to enable an addict to bear toothaches uncomplainingly.

Many of the Philadelphia addicts showed chronically inflamed throats and an atypical blood-pressure change when they stood up after lying down. Both of these signs, the Philadelphia researchers noted, are to be expected in excessive cigarette smokers--- and all of their narcotics addicts also smoked cigarettes excessively. 13

A similar study made at Bellevue Hospital in New York City yielded similar findings. Dr. George B. Wallace summed up both studies: "It was shown that continued taking of opium or any of its derivatives resulted in no measurable organic damage. The addict when not deprived of his opium showed no abnormal behavior which distinguished him from a nonaddict." 14

"Since these studies appeared," Dr. Harris Isbell, director of the Public Health Service's Addiction Research Center in Lexington, pointed out in 1958, "it has not been possible to maintain that addiction to morphine causes marked physical deterioration per se." 15

Through the years, this has been the view of authorities familiar with addiction. Thus Dr. Walter G. Karr, the University of Pennsylvania biochemist who participated in the Light-Torrance Study, reported in 1932: "The addict under his normal tolerance of morphine is medically a well man." 16

In 1940 Dr. Nathan B. Eddy, after reviewing the world literature on morphine to that date, concluded similarly: "Given an addict who is receiving [adequate] morphine ... the deviations from normal physiological behavior are minor [and] for the most part within the range of normal variations." 17

Three other authorities who had long worked with heroin addicts from New York City's slums--- Drs. Richard Brotman, Alan S. Meyer, and Alfred M. Freedman--- had this to add in 1965: "Medical knowledge has long since laid to rest the myth that opiates inevitably and observably harm the body." 18

Further confirmation of this point was reported in 1967 by a specialist in human metabolism, Dr. Vincent P. Dole of the Rockefeller University, and his wife, Dr. Marie Nyswander, a psychiatrist with broad experience among addicts (see Chapter 14). After examining and testing addicts who had long been addicted to heroin, * Dr. Dole made a significant comparison: "Cigarette smoking is unquestionably more damaging to the human body than heroin." 20

* Drs. Dole and Nyswander found a somewhat higher level of white blood cells in the blood of some addicts prior to treatment--- an effect others had noted earlier. White blood cells, of course, protect the body from infections; but an excess of them is worrisome because it may be a sign of bone-marrow pathology or of infection somewhere in the body. The bone marrow of these addicts, however, was normal, and no other infection was detected. 19

There is a similar disparity between the popular and the scientific views of the effects of the opiates on the human mind. In 1938, Dr. Lawrence Kolb, Assistant Surgeon General of the United States Public Health Service, and first superintendent of the service's hospital for addicts in Lexington, Kentucky, and Dr. W. F. Ossenfort reported that of more than 3,000 addicts admitted to the hospital at Lexington, not one suffered from a psychosis caused by opiates. 21

In 1946, Drs. A. Z. Pfeffer and D. C. Ruble compared 600 male addict prisoners at the Lexington hospital with male nonaddict prisoners serving sentences of the same length. Psychoses were no more common among the addicts than among the nonaddicts. Controlled tests showed that there had been no intellectual deterioration due to morphine. Drs. Pfeffer and Ruble concluded: "The data of this study indicate that the habitual use of morphine does not cause a chronic psychosis or an organic type of deterioration ." 22

In 1956 Dr. Marie Nyswander noted similarly: "The incidence of insanity among addicts is the same as in the general population ." 23

Also in 1956, Dr. George H. Stevenson and his British Columbia associates gave complete neurological and psychiatric examinations to imprisoned addicts, and questioned them and their relatives in an attempt to find mental deterioration. They reported: "As to possible damage to the brain, the result of lengthy use of heroin, we can only say that neurologic and psychiatric examinations have not revealed evidence of brain damage.... This is in marked contrast to the prolonged and heavy use of alcohol, which in combination with other factors can cause pathologic changes in brains, and reflects such damage in intellectual and emotional deterioration, as well as convulsions, neuritis, and even psychosis." 24

The British Columbia report continued:

Our psychological studies do not support the common assertion that long continued heroin use produces appreciable psychological deterioration. So far as we can determine, the personality characteristics commonly seen in addicts are assumed to have been largely present before their addiction, and the same characteristics are commonly seen in most recidivist [relapsing] delinquents who do not use narcotic drugs.

Moreover, it is not evident that these personality weaknesses are aggravated or made worse by addiction as such. Years of crime, years of prison, years of unemployment, years of anti-social hostility (and society's anti-addict hostility), years of immorality--- these can hardly be expected to strengthen a personality and eradicate its weaknesses. If "years of addiction" is added to these other unfavorable behavioral and environmental factors, why should the personality deterioration (if measurable) be attributed to drug addiction as if it were the only responsible factor? 25

Drs. Harris Isbell and H. F. Fraser of the Public Health Service addiction center in Lexington, Kentucky, reported in 1950: "Morphine does not cause any permanent reduction in intelligence." 26

The British Columbia group in 1956 went to considerable pains to check this finding. They dug up old child guidance clinic records and other childhood test records that could be compared with tests run on the same subjects following years of addiction to heroin. If a promising child with a high I.Q. turned into a dull adult opiate addict with a low I.Q., opiates might be suspected as the cause of the deterioration. The cases studied, however, pointed in the opposite direction. In a number of cases, addicts who had normal or superior I.Q.'s while addicted were found to have had subnormal I.Q.'s as children. The British Columbia researchers accordingly abandoned this line of investigation, on the ground that "the comparative psychological results were undependable." 27 The British Columbia report also noted: "We found most of the addicts very likeable people. On the whole, they were friendly, cooperative, interested and eager to talk freely and frankly about themselves. Many of them have sensitive minds, are interested in their own psychological reactions and in philosophical problems generally. They were, on the whole, not self-conscious, were self-possessed, courteous and helpful." 28

In 1962 Dr. Kolb added that "Chronic psychoses as a result of the excessive use of opiates are virtually non-existent." 29

In 1963, Deputy Commissioner Henry Brill of the New York State Department of Mental Hygiene, chairman of the American Medical Association's narcotics committee, after a survey of 35,000 mental hospital patients, summarized the data in these terms: "In spite of a very long tradition to the contrary, clinical experience and statistical studies clearly prove that psychosis is not one of 'the pains of addiction.' Organic deterioration is regularly produced by alcohol in sufficient amount but is unknown with opiates, and the functional psychoses which are occasionally encountered after withdrawal are clearly coincidental, being manifestations of a latent demonstrable pre-existing conditions." 30

Such views had long been commonly accepted among physicians. "That individuals may take morphine or some other opiate for twenty years or more without showing intellectual or moral deterioration," Dr. Kolb wrote in 1925,

is a common experience of every physician who has studied the subject. . . .

The criterion for lack of deterioration in individuals originally useful and in good standing in the community has been continued employment in useful occupations, the respect of associates, living in conformity with accepted social customs, avoidance of legal prosecution except those brought about by violations of narcotic laws, undiminished mental activity, and unchanged personality, or, when this could not be determined, the possession of a personality that would be considered by psychiatrists to be within the range presented by nervously normal individuals or mild psychoneurotics.

We think it must be accepted that a man is morally and mentally normal who graduates in medicine, marries and raises a family of useful children, practices medicine for thirty or forty years, never becomes involved in questionable transactions, takes a part in the affairs of the community, and is looked upon as one of its leading citizens. The same applies to a lawyer who worked himself up from a poor boy to one of the leading attorneys in his county, who became addicted to morphine following a severe abdominal disease with recurrence and two operations, and who continued to practice his profession with undiminished vigor in spite of his physical malady and the addiction.

Such cases as are cited above, and they are not uncommon, have taken as much as 15 grains [900 milligrams] of morphine daily for years without losing one day's work because of the morphine. 31

There is thus general agreement throughout the medical and psychiatric literature that the overall effects of opium, morphine, and heroin on the addict's mind and body under conditions of low price and ready availability are on the whole amazingly bland. When we turn from overall effects to detailed effects, however, there is somewhat less unanimity of expert opinion.

Effect on sexual potency and libido. It is impossible to supply a succinct and authoritative account of the specific effects of opiates--- or other drugs--- on sexual behavior and response, for two reasons. First, as noted in the Introduction, no psychoactive drug has uniform effects. The effects vary from person to person and from time to time in a specific person. They vary with dose, with the expectations and desires of the user, and with the circumstances surrounding use. Thus one user may report that a drug is a sexual stimulant; another may report that the same drug is a sexual depressant.

Second, nobody has studied the sexual effects of drugs under controlled laboratory conditions. For most drugs, we can hardly even offer an informed guess--- except to suggest that the sexual effects (whether favorable or unfavorable) are probably less specific and less impressive than is usually alleged.

With respect to heroin and the other opiates, there is some anecdotal and some survey information. Both male and female addicts generally report that the opiates reduce sexual desire. This is no doubt an unwelcome side effect for many people--- though it has also been suggested that some people turn to opiates because these drugs shield them from distressing sexual desires.

Many addicts report that the opiates have an effect on male sexual performance which they find desirable; ejaculation is delayed or even blocked altogether, so that coitus can be greatly prolonged or even continued indefinitely. It is said that in India during the nineteenth century this was a major reason for taking opium.

Male sexual potency is retained, at least in part, except when very large doses are taken. *

* Dr. Lawrence Kolb reported (1925): ". . . it was learned from addicts in this series [of 230 cases studied] that [male sexual] potency is not completely abolished until the daily dose of heroin or morphine is 15-30 grains [900 to 1,800 milligrams $450 to $900 worth per day at 1971 New York City black-market prices]. Desire is reduced by much smaller doses, but considerable potency remains. One thirty-five year addict raised ten children. Others addicted for years had families of average size, and men beyond sixty who bad been addicted twenty years or more reported sexual competency." 32

The addicts studied in the 1956 British Columbia study were highly active sexually--- starting at an early age and continuing with many partners--- before they became addicted. Almost all sexual activity, both before and after addiction, was heterosexual.

"In the heterosexual aspects," the British Columbia group reported, "it is well known that opium and its derivatives exert a mild aphrodisiac action for a time, but after heavy drug use has developed, the heterosexual urges are less strong and potency is commonly reduced." 33 Forty-nine of fifty men in the British Columbia study said that narcotics decreased their libido; 34 the decrease, however, was from a remarkably high pre-addiction level. Among the women, 13 out of 21 reported decreased libido when on heroin. One, however, reported increased libido, and 7 reported no change. 35

A 1970 study revealed that many Philadelphia addicts thought their sexual functioning was adversely affected while they were on heroin. The study did not differentiate, however, between the effects of the heroin itself and the other depressing aspects of the street addict's way of life. 36 Perhaps the best evidence for a depressant effect of heroin on both potency and libido is the fact that addicts who complain of reduced libido and impaired sexual performance while on heroin report prompt improvement when they "kick the habit." In a group of 13 ex-addicts intensively studied at St. Luke's Hospital in New York City, for example, all "claimed their sexual problems disappeared during detoxification, whether in hospitals, detention, jails, etc." 37 There are even reports of spontaneous orgasm in males during withdrawal from opiates. All of the evidence suggests that heroin temporarily depresses rather than permanently damages sexual function.

Effect on menstruation. Some women addicts stop menstruating while on heroin; others report delayed menstruation and other menstrual irregularities. Most observers consider this a direct effect of the heroin though Drs. George Blinick, Robert C. Wallach, and Eulogio Jerez, on the basis of experience with hundreds of young women addicts at the Beth Israel Medical Center in New York, believe that menstrual irregularities may result in part at least from the generally stressful life which addicts lead on the streets of New York. 38

Effect on likelihood of pregnancy.Women addicts can become pregnant while on heroin, but the likelihood of pregnancy is reduced. How much of the reduction is due to the heroin itself and how much is traceable to other aspects of being a heroin addict in the United States today (malnutrition, infection, and so on) is not known.

Effect on childbirth. It is often stated that pregnant addicts suffer "a high incidence of maternal complications such as toxemia, abruptio placentae, retained placenta, postpartum hemorrhage, prematurity by weight, breech delivery, and high neonatal morbidity and mortality." 39 This may be true. Such complications of pregnancy, however, are also associated with poverty, malnutrition, infection, and lack of prenatal care. No controlled studies have been made of the relative incidence of complications of pregnancy among addicted and nonaddicted women from the same neighborhood and socioeconomic status.

The findings of Drs. Blinick, Wallach, and Jerez cast some doubt on the conventional view. They studied 100 consecutive births to addicts at Beth Israel. Many of the mothers suffered from malnutrition, and 18 had positive blood tests for syphilis. Many earned their living by prostitution. Individual mothers also suffered from such conditions unfavorable to a healthy pregnancy as cancer (carcinoma in situ of the cervix), rheumatic fever, anemia, hepatitis and other forms of liver disease, epilepsy, and Class A diabetes. One addict had had ten babies; another was over forty years old; many had a history of using other drugs in addition to heroin. Almost all were heavy cigarette smokers. Two had had prior cesarean sections. Despite this concentration of unfavorable antecedent conditions, 88 of the 100 mothers gave uneventful birth to healthy babies. * The chief divergence from normal noted was low birth weight--- a condition known to be associated with poverty and with cigarette smoking. Breech deliveries were also frequent; these were probably associated with low birth weight and thus with cigarette smoking and poverty. "In this series, contrary to reports and expectations," the Beth Israel team summed up, "there have been few serious complications." 41

* The standard test for the condition of a baby at birth, the "one-minute Apgar test," rates such factors as breathing, crying, color, etc. The scale runs from 0 to 10. Eighty-nine of the 100 babies born to heroin addicts had high (8, 9, or 10) Apgar scores. 40

In a series of 230 babies born at Beth Israel to addicted mothers, only two had congenital defects 42 --- a rate which would be considered low in a group of nonaddicted mothers.

Effect on babies born to addicted mothers. Morphine and heroin, like alcohol and nicotine, are believed to pass through the placenta and reach the unborn baby. They are also believed to enter the mother's milk, so that a breast-fed baby is maintained on the drug and is weaned from the drug as it is weaned from the breast. There are numerous reports of withdrawal symptoms in babies who are not breast-fed; and at some hospitals opiates or other drugs are administered if a baby born to an addicted mother exhibits what appear to be opiate withdrawal symptoms.

There is not full agreement, however, on the conventional views summarized above. Thus Drs. Blinick, Wallach, and Jerez have some doubts concerning the passage of opiates to the fetus. "Placental transfer of narcotics prior to and during labor is poorly understood and the conclusions of experimentation are open to doubt," they report . 43

"The minute amounts of morphine that pass the placenta barrier," Dr. Blinick reported sometime later, "cannot be detected by ordinary biochemical methods." 44 In the Beth Israel series of 100 consecutive births to heroin addicts, it proved unnecessary to administer opiates to the babies. The many reports that such babies require opiates are all based on clinical judgment; no one has divided babies into two groups at random to see whether babies who receive opiates do better than babies who merely receive good care.

Dr. Saul Blatman, the pediatrician at Beth Israel in charge of the care of the babies in the Blinick-Wallach-Jerez sample, points out that many infants born to heroin addicts, like many born to other ill or poverty stricken mothers, suffer from low birth weight and other signs of immaturity. The symptoms commonly attributed to heroin "withdrawal" may thus in fact be due to immaturity of the nervous system. Indeed, "when we talk about symptomatology in the baby, we should not label these babies as addicted, because there is no indication that they are." Dr. Blatman similarly urges that the term "withdrawal symptoms" as applied to the babies of addicts "is an unsatisfactory term, which we should eliminate."

Dr. Blatman warns particularly against "standing orders" to administer opiates or other drugs to these babies; where standing orders are in effect, "many of these babies are often 'snowed under' by depressant medication starting soon after birth." While hyperirritable babies born to addicted mothers (like those born to nonaddicted mothers) may need medication--- phenobarbital, chlorpromazine, or in some instances paregoric (an opiate)--- the treatment should be individualized and matched to each baby's need. 45

In sum, many babies born to addicted mothers are born in excellent health; others suffer a handicap. How much of this handicap is traceable to the heroin and how much to malnutrition, infection, and other adverse factors has not been determined.

We shall return to these subjects-sexual libido and potency, menstrual functions, pregnancy, and childbirth in Chapter 16.

Effect on diagnosis of illness. An addict on morphine or heroin can feel and recognize pain. By making him more tolerant of pain, however, an opiate may lead him to postpone seeing a doctor or dentist when pain arises; thus treatment may in some cases be delayed and cure made more difficult or impossible. Poverty, of course, may also delay medical and dental treatment.

Effect on pupils of the eyes.Opiates produce in most users a constriction of the pupils of the eyes, which can decrease ability to see well in the dark. This effect usually persists, even with prolonged use of opiates.

Effect on digestion. The opiates are constipating. Indeed, codeine and opium itself (as tincture of opium or paregoric) are commonly used as a treatment for diarrhea. Some addicts must compensate for this constipating effect by taking a laxative or other aid to elimination; others have no long-term problem. "Street" heroin is sometimes adulterated with mannite, a mild laxative, to counteract the constipating effect.

Effect on stability of mood. A very serious shortcoming of the opiates in common use, morphine and heroin, is their brief period of action. An addict must take his drug two, three, or even four times a day to forestall withdrawal symptoms. Addicts whose supply is uncertain may thus tend to "bounce" from a satisfied to an incipient withdrawal state several times a day.

Effect on sweat glands. Some addicts report profuse perspiration, even after long periods on heroin or other opiates.

Other side effects. Any survey of heroin users turns up a wide variety of other complaints; headaches, joint pains, hiccups, diarrhea, nervousness, running nose, difficulty urinating, and unhappiness were among the side effects reported in a recent Stanford University survey. 46 These reports no doubt result at least in part from the natural human tendency of addicts and nonaddicts alike to attribute whatever happens to whatever drug one currently happens to be taking.

These, then, are the deleterious physiological effects on addicts traceable to the opiates themselves. Those traceable to the narcotics laws, and to the heroin black market flourishing under those laws--- including the so-called heroin overdose deaths--- will be discussed in Chapter 12.

16. Walter G. Karr, cited in Drug Addiction: Crime or Disease? Interim and Final Reports of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs (Bloomington, Ind.: Indiana University Press, 1961), p. 47. Hereinafter cited as ABA-AMA Report.

36. William F. Wieland and Michael Yunger, in Proceedings, Third National Conference on Methadone Treatment, New York, November 1970, sponsored by National Association for the Prevention of Addiction to Narcotics (NAPAN) and co-sponsored by National Institute of Mental Health; U.S, Public Health Service Publication No. 2172 (Washington, D.C.: U.S. Government Printing Office, 1971), pp. 50-53. Hereinafter cited as Proceedings, Third Methadone Conference.